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Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With OSA
TAKE-HOME MESSAGE
- This randomized noninferiority trial investigated the effectiveness of a mandibular advancement device (MAD) compared with that of CPAP in reducing 24-hour ambulatory blood pressure among patients with moderate to severe obstructive sleep apnea (OSA) and hypertension. Treatment with the MAD was associated with a greater reduction in blood pressure than treatment with CPAP.
- These findings suggest that the MAD is a viable alternative to CPAP in patients with OSA, with a potential for higher patient compliance owing to ease of use. Clinicians should consider treatment with a MAD for patients with OSA who are unable or unwilling to use a CPAP machine.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Hypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for patients who decline or cannot tolerate CPAP.
OBJECTIVE
We compared the relative effectiveness of MAD versus CPAP in reducing 24-hour ambulatory BP.
METHODS
In an investigator-initiated, randomized, non-inferiority trial (pre-specified margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and increased cardiovascular risk were recruited at 3 public hospitals for polysomnography. Of these, 220 participants with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥15 events/hour) were randomized to either MAD or CPAP (1:1). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and 6 months.
RESULTS
Compared to baseline, the 24-hour mean arterial BP decreased by 2.5 mmHg (P = 0.003) at 6 months in the MAD group, whereas no change was observed in the CPAP group (P = 0.374). The between-group difference was -1.6 mmHg (95% confidence interval: -3.51 to 0.24, non-inferiority P < 0.001). The MAD group demonstrated a larger between-group reduction in all secondary ambulatory BP parameters compared to the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with the between-group difference similar (P = 0.384). There were no between-group differences in cardiovascular biomarkers.
CONCLUSION
MAD is non-inferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk.
Additional Info
Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients with Obstructive Sleep Apnea
J Am Coll Cardiol 2024 Mar 13;[EPub Ahead of Print], YH Ou, JT Colpani, CS Cheong, W Loke, AT Thant, EC Shih, F Lee, SP Chan, CH Sia, CY Koo, S Wong, A Chua, CM Khoo, W Kong, CW Chin, P Kojodjojo, PE Wong, MY Chan, AM Richards, PA Cistulli, CH LeeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.